CLINICAL HANDBOOK OF SCHIZOPHRENIA

50. Jail Diversion 531cates that jail diversion programs can successfully divert people from criminal justice processing.What is less clear is the programs’ ability to link diverted individuals to appropriate,evidence-based treatment for severe mental illness, co-occurring substance abusedisorders, and a host of other medical and social problems. The continuing challenge formental health clinicians and policymakers is to mobilize sufficient and effective interventionsfor this population. The goal of providing care in the least restrictive setting is elusiveand often does not provide effective treatments. A number of treatments with knowneffectiveness have not yet been made available in sufficient quantity or duration to helppeople with severe mental illness stay out of jail. This remains one of the greatest challengesin community mental health.Parallel Systems of CareCurrent mental health and criminal justice policies have created parallel systems of carefor treating persons with severe mental illness in both community and correctional settings.For many communities, allocating more dollars to mental health services in correctionalsettings often means there are fewer dollars available to support community-basedtreatment. This creates a situation in which scarce resources for mental health care arestretched between two inadequate systems of care. If inmates are to be confined againsttheir will in detention settings, the U.S. Constitution requires that their health care needsbe met. The implications seem clear enough. As many persons with severe mental illnessas possible should be diverted from the criminal justice system to community care. Untilcommunity care is adequately funded, however, persons with mental illness will continueto pass through the revolving door of jails and prisons.Who Benefits, Who Pays?Jail diversion programs are precarious efforts that try to link two systems that, left totheir own separate priorities, usually have competing philosophies and objectives. Withdistressed mental health and corrections budgets at all levels of government, diversionprograms often fall between the cracks, with neither system feeling ownership or responsibilityto fully fund these diversion programs. Typically, jail diversion programs, bothpre- and postbooking, are started with Federal or state seed money. Unfortunately, oncethese Federal or state demonstration dollars stop, most jail diversion programs eithercease operations altogether or convert to a more generic and less effective service modality.Current evidence points to a mismatch between who benefits and who pays for jail diversionprograms, with local mental health authorities shouldering more of the costs andcorrectional programs realizing more of the benefits. One goal, then, is to strive for partnershipand collaboration among mental health and criminal justice stakeholders, suchthat the costs and benefits of jail diversion can be shared by both.Here is where services research can come to the aid of clinical practice. Researchaimed at establishing the cost-effectiveness of calibrated interventions—those designed tomeet the varying needs of people with mental illness in the criminal justice system—cango a long way toward sustaining jail diversion efforts. The challenge here is that currentevidence suggests that diversion is not cost-effective, but no long-term studies that examinethe balance of up-front costs and downstream savings have been conducted. To theextent that research could address the value-added nature of diversion, then there wouldbe a stronger evidence base for insisting upon adequate funding for programs that improvecommunity living opportunities for the thousands of persons with mental illnessnow caught up in the criminal justice system.